Post on 31-May-2020
Standardization Required for Meaningful Use Implementation
Marty LaVenture, MPH, PhD
Director, Office of Health Information Technology & Center for Health Informatics & Minnesota e-Health Initiative
Minnesota Department of Health
Meaningful Use for Public Health Professionals: Basic TrainingMay 16, 2011 – CDC
May 24, 2011 – AMIA
Office of Surveillance, Epidemiology, and Laboratory Services
Public Health Informatics and Technology Program Office
Disclaimer
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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Objectives
Describe why standards are necessary but not sufficient for interoperability and exchange
Define key terms
Describe types of standards related to meaningful use
Identify domains that require local implementation guides
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Your Challenge During This Session
Identify one key term or concept that is new to you and be prepared to: Define the concept
Explain what you learned about that concept today, or what new insights you had
Relate the concept to responsibilities
within your organization
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Topics for Discussion
A Perspective and Context • The Role of Public
Health Informatics
Meaningful Use Incentive Program• Requirements for
Public Health • Standards and
Interoperability • Immunization
Example
Implications and Opportunities • Recommendations
for Action
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A PERSPECTIVE AND CONTEXT The Role of Public Health Informatics
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Context: Public Health Systems in Transition
Public health information systems today need to:
Adapt to the accelerated pace for e-Health – especially expectation for interoperability
Increase pace for modernization and sophistication
Foster cross jurisdictional collaboration for requirements, standards and implementation
Techno-logy Content Processe
sWork-force
Public Health
Systems
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HEALTHIERCOMMUNITIES
Using Informatics to Improve Public Health Practice
PRACTICE
WISDOM
KNOWLEDGE
INFORMATION
DATA
An INFORMATICS SAVVY ORGANIZATION is one that has an informatics-skilled workforce, a disciplined approach to information system design and use, and reliably managed IT operation.
PH INFORMATICSimplies a disciplined
approach to informationsystems design and use that
drives improvements in publichealth practice.
PUBLIC HEALTH PRACTICE
LEVE
L O
F VA
LUE
Adapted by: Marty LaVenture, Bill Brand, Minnesota Department of Health. Karen Zeleznak, Bloomington Division of Public Health, 2005
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% Office-based Physicians With Basic Systems(by state, preliminary 2010)
Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates by Chun-Ju Hsiao, Ph.D.; Esther Hing, M.P.H.; Thomas C. Socey; and Bill Cai, M.A.Sci., Division of Health Care Statistics 9
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"Physician clinic" means any location where primary or specialty care ambulatory services are provided for a fee by one or more physicians in the state of Minnesota.
2010 MN Health Information Technology (HIT) Ambulatory Clinic Survey (87% response rate)
Example: EHR Adoption of Clinics (N = 1121) - Minnesota 2010
Primary Care Clinics
Long Term CareState Health Department
Large Hospitals
Pharmacies
What strategies will shorten these lines and help move them to the right?
Radiology
Estimated range of adoption based on various surveys and other sources Minnesota Department of Health, rev 2010.
Local Health Depts
Small Hospitals
Assess Plan InteroperateReadinessEffective UseImplementSelect
Achievement of 2015 Mandate
Continuumof EHR
Adoption
Adopt ExchangeUtilize
MN Model for Adopting Interoperable EHRs
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MEANINGFUL USE INCENTIVE PROGRAM
Requirements for Public Health Standards and Interoperability Immunization Example
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1. Unless an EP, eligible hospital or CAH has an exception for all of these objectives and measures they must complete at least one in this group as part of their demonstration of a meaningful use to be eligible for incentives.
2. Public health agencies may specify how to test the data submission and to which specific destinationSource: Dr. Paul Kleeberg, Clinical Director, Key Health Alliance
Communicate with public health agencies
Stage 1 (2011-2012) Meaningful Use Menu: Improve Population and Public Health
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Standards for Public Health Transactions in Stage 1 Meaningful Use
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The electronic movement of health-related information among organizations according to nationally recognized standards.
Source: Report to the ONC on Defining HIT Terms, April 2008. http://www.nahit.org/docs/hittermsfinalreport_051508.pdf
Related Terms HIO – Health Information Organization
NwHIN – Nationwide Health Information Network
Connect Project – Federal Agencies and NwHIN
Direct Project – Standards, Services and Policy
HISP – Health Information Service Provider
Health Information Exchange (HIE)
What are the tools in the Nationwide Health Information Network toolkit?
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DirectedExchange
Directed Exchange with Value-Added
Intermediaries
Longitudinal data access across settings of care within a community
Cross-Community Access
Less Complex
Very Robust
Scenarios Tools
Direct
Query for Documents
Document Submission*
Patient Discovery
Retrieve Documents
* Not currently in Nationwide Health Information Network toolkitSource: ONC – April 2011
Meaningful Use and Public Health Reporting for Immunizations
Successful data submissions to MIIC* include these characteristics: Submitted from a certified EHR technology and,
Follows HL7 Version 2.3.1 / 2.5.1 specifications
Includes accepted CVX codes
Sent via a secure transport mechanism such as: • File upload via HTTPs
• PHINMS message
• Transfer via a secure ftp server
• Message via HIO or other Intermediary
• Other options are being evaluated
*Minnesota Immunization Information Connection (MIIC) 17
Example: Minnesota Direct Pilot Project
Internet
Sends Batch Flat File of Immunizations
(Will Migrate to HL7 VXU)
HISP NetworkSecure Data Facility
Internet
MDH / MIIC
Receives Direct Message
Routes thru PHINMS
Receives via PHINMS Edge Protocol Stores in
MIIC Registry
HCMC
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Reference: http://www.ehealthinitiative.org/
Adapted from Minnesota Department of Health and HL7, guide to interoperability
Interoperability: The ability of two or more systems or components to exchange information and to use the information that has been exchanged accurately, securely, and verifiably, when and where needed.
And “it is comprised of ‘technical,’ ‘semantic’ and ‘process’ interoperability, ….”
Definition of Interoperability
The arena of standards and health information exchange is highly dynamic; check for the latest updates at www.health.state.mn.us\e-health
Components of Standards Guide – Updated June 2010
Electronic Health Information Exchange
Coordination with National Efforts on Standards
Minnesota e-Health Framework for Interoperability
Key Actions for Achieving and Advancing Electronic Health Information Exchange
Standards Recommended for Use in Minnesota (as of June 2010)
Interoperable Electronic Health Record
Requirements
Electronic Prescription Drug Program
Laboratory Results Reporting
Immunization Information Exchange
Exchange of Clinical Summaries
Annotated Resource List
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Critical Role for Implementation Guides
The current HL7 guide for immunization messaging was Created with CDC and AIRA*
Involved large state grantee base in its creation
Published in 2000
An example of CDC, a volunteer organization, and grantees working together
* American Immunization Registry Association (AIRA)21
IMPLICATIONS AND OPPORTUNITIES
Recommendations for Action
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Summary / Action Recommendations
Understand that meaningful use is part of larger e-health transformation
Support workforce information / education Especially in public health informatics
Develop, adapt, and distribute resources quickly Guides, templates, tools, protocols, policies
Monitor state and national activities
Actively communicate and coordinate agency efforts
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Your Challenge During This Session
Identify one key term or concept that is new to you and be prepared to: Define the concept
Explain what you learned about that concept today, or what new insights you had
Relate the concept to responsibilities
within your organization
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Health IT Standards Committee (a Federal Advisory Committee) =-- Make recommendations to ONC on standards, implementation specifications, and certification criteria for the exchange and use of health information. http://healthit.hhs.gov/standardscommittee
Final Rule – HIT : Initial Set of Standards, Implementation Specifications, & Certification Criteria for EHR Technology -http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf
HL7 v2.5.1 Implementation Guide for Immunization Messaging (release 1.1; 08/15/2010) http://www.cdc.gov/vaccines/programs/iis/stds/downloads/hl7guide-08-2010.pdf
HL7 v2.5.1 Implementation Guide for Electronic Lab Reporting - In development through collaborative efforts and will be available in Summer 2011
National Resources Standards and Meaningful Use
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Minnesota e-Health Initiative
http://www.health.state.mn.us/e-health/index.html
Minnesota Public Health Reporting for Stage 1 Meaningful Use - http://www.health.state.mn.us/e-health/phreportmu0411.pdf
Meaningful Use Incentives and MIIC
http://www.health.state.mn.us/divs/idepc/immunize/registry/hp/mu.pdf
MN e-Health Standards Guide (updated 2010)
http://www.health.state.mn.us/e-health/summit/g2standards2009.pdf
State Resources From Minnesota Standards and Meaningful Use
AcknowledgementPublic Health Informatics is a Team Activity
MDH
Emily Emerson MIIC, Priya Rajamani, Sr. Informatician, Asa Schmit, MEDSS, MIIC, IS&TM and OHIT/e-health teams
Public Health Informatics Institute
Bill Brand, Dave Ross
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